Provider Demographics
NPI:1417015777
Name:BAKAEN, KARMEN
Entity Type:Individual
Prefix:
First Name:KARMEN
Middle Name:
Last Name:BAKAEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E 17TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8622
Mailing Address - Country:US
Mailing Address - Phone:714-564-9000
Mailing Address - Fax:714-564-9024
Practice Address - Street 1:1710 E 17TH ST STE E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8622
Practice Address - Country:US
Practice Address - Phone:714-564-9000
Practice Address - Fax:714-564-9024
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46360122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46360-01OtherMEDICAL